Medical Marijuana

[Mr. Furious]

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Ethical question time! Picture yourself in an interview for your number one choice medschool and they ask you:

"What is your opinion on medical marijuana? Do you believe a doctor should prescribe it to terminally ill patients? As a doctor, will you prescribe it?"

What I want to know is, what answer would you give them....and what would your REAL answer be? :wink: You know, the answer you edited out in your head.

 

[matthew0126]

not an opinion on this issue, but my 2 cents:

just say whatever you believe (with of course, articulate and well-thoughtout points)... if the school has no tolerance for a different position on topics, you don't want to go there

 

[Dr. Dad]

ok here are my answers:
For the interview:
I feel that if the medical problem can be fixed efficiently and consistanlty with the use of marijuana I see no reason why I should not prescribe it.
Off the record:
I would prescribe it, but I would discriminate with whom I would prescribe it. If an 85 year old lady with arthritis pain wants it, sure no problem. But if a 32 year old man with dime size bruise on his forearm wants it, forget it.
Not just because I don't think he really needs it, but also because I think marijuana would do more harm than good to a young man or woman as far as their job, kids, freinds, etc.
A case by case situation I guess.

 

[vyc]

i think if marijuana has a pain-relieving effect, i don't see why it shouldn't be used medically.

if it's legal, yes i would prescribe it, as long as there isn't a better alternative.

that's the answer i would both give to the interviewer and that i really believe.

 

[none]

Yeah, the key there is it being legal. It's not, anywhere. Thus the issue should be very easy to respond to.

 

[tulanestudent]

I really don't see why it's illegal anyway. There is NO real potential for addictiveness, whereas cigarrettes, alcohol, and many legal prescription pain meds are clearly addictive. Yes, there are detrimental side effects to chronic use - impairment of driving and job-related tasks. But, as compared with most other illegal drugs, it's really no more harmful than alcohol. This is all objective information from medical sources I've read over the years. I suggest you research some of these facts to back up an argument for the safety of the drug, especially as compared to other prescription pain alternatives. If you have your facts straight, and EMPHASIZE THE IMPORTANCE OF PROVIDING COMFORT TO THE PATIENT, WITH SAFETY OF THE PATIENT IN MIND, I don't think anyone can hold it against you for supporting a controversial treatment.

 

[tulanestudent]

I forgot to add, you must also mention that you would only follow the law in your state at that time. We all have to obey laws, or we risk losing our medical liscencing.

 

[med student]

I really am hoping that in the next ten years that medical marijuana will be legalized in the whole country for serious medical conditions. The only criteria for legalizing medical marijuana should be whether or not it helps relieve the suffering of seriously ill pateints. The only potential problem I see in the legalization of medical marijuana is that both polictical parties are afraid to do it because who ever does it first will come off looking like they are soft on crime and then they will not get elected the next time around.

 

[med student]

•••quote:••• I really don't see why it's illegal anyway. There is NO real potential for addictiveness ••••This is a common saying I hear all the time from people talking about legaling marijuana but I feel that it is completely wrong. While marijuana does not have physical addiction like cigarettes it does have a psychological addiction. This can be very serious for some people and I have seen it first hand because I lived with several people who were seriouisly addicted to marijuana and I can say for sure it affected their college career. I am sure that some people do not believe in the psychological addiction but it does exist. Addiction by definition is continued use of the drug after the user is aware of the serious consequences that it is having on their life. Now after saying all this I am not saying that marijuana should be illegal I just think it is important to point out that it does have serious consequences for a small percentage of the users just like alcohol does.

 

[Street Philosopher]

I think it's fairly clear what you should do as a physician. As a physician, not only do you have to follow the ethical guidelines of the profession, but you have to base your decisions on facts and research. Research has repeatedly shown that marijuana has no medical benefits. Furthermore, it is against the law to prescribe marijuana as medicine. It's clear that marijuana should not be prescribed by physicians... at this point in time.

edit: overstated that marijuana has been proven to have no medicinal effects - what I meant to say is that there as been no proven medicinal effects.

 

[med student]

•••quote:••• Research has repeatedly shown that marijuana has no medical benefits. ••••I don't think that this is true. Right now they are in the process of studying marijuana to see if it has any medical benifits. It is currently accepted that marijuana decreases the naseau associated with chemo, the controversy is whether other drugs can do it as well. Some patients claim that only marijuana can relieve their naseau from chemo so research needs to be done to determine what is the most effective drug for treating this problem. Another area that marijuana has the potential to help is in treating the AIDS patients in the end of the disease who are not eating and are wasting away. It is a common side effect of marijuana that a person gets very hungry after smoking so if it will help a seriously ill patient gain weight then I feel it is justified in its use. The point is marijuana has some potential benifits but also some potential side effects and it needs to be studied just like any other medication would be.

 

[Jamier2]

•••quote:•••Originally posted by med student:
•Right now they are in the process of studying marijuana to see if it has any medical benifits. It is currently accepted that marijuana decreases the naseau associated with chemo, the controversy is whether other drugs can do it as well... Another area that marijuana has the potential to help is in treating the AIDS patients in the end of the disease who are not eating and are wasting away. The point is marijuana has some potential benifits but also some potential side effects and it needs to be studied just like any other medication would be.•••••I think if they discover the mechanisms that cause the benefits of marijuana, they could likely make a designer drug that will produce the same results. As for the AIDS patients, or terminally ill patients for that matter, I say until they do come out with drugs, why not? If I was going to die in 6 months, and smoking some MJ would ease my suffering, I'd be at the dealer ASAP. 🙂

The best result of this research I can see would be isolating the chemicals which are beneficial, and administering them is a form which isn't as unhealthy as smoking weed. Argue if you want to, but smoke of any kind isn't the best thing to have in your lungs. 🙂

 

[Scooby Doo]

•••quote:•••Originally posted by Schoolboy:
•I think it's fairly clear what you should do as a physician. As a physician, not only do you have to follow the ethical guidelines of the profession, but you have to base your decisions on facts and research. Research has repeatedly shown that marijuana has no medical benefits. Furthermore, it is against the law to prescribe marijuana as medicine. It's clear that marijuana should not be prescribed by physicians... at this point in time.•••••Damn dude,
You don't know much about marijuana do you? It has definitely been shown to increase appetite and serve to decrease nasuea. IN ADDITION, you are in Los Ang, CA!!! Last time I looked, Prop 215 (I think it was that one??) passed and marijuana IS LEGAL for CA residents with proper permission.

 

[oneironaut]

Okay.. Here's what the AMA says:
Schoolboy: Go do your homework friend.

<a href="http://www.ama-assn.org/ama/pub/article/2036-4971.html" target="_blank">AMA report on Medical Marijuana</a>

Here's another good site , I'm sure many are familiar with PubMed:

<a href="http://www.ncbi.nih.gov/entrez/query.fcgi" target="_blank">PubMed</a>

_________________________________________________
Now, to the matter at hand:

Med Student: you raise a good point, psychological addiction has real affects; much like placebos in that respect. But it's important to remember a couple things:
1) what population are we talking about? Are we worried about the psychological addiction in patients with serious disorders like cancer? HIV? Are we worried they will sit on the couch all day and not 'be productive'? Is it AS important that they have the willpower to quit? Note, these arguments will be very similar to those for or against the prescription of narcotics.
2) 'It's illegal' okay, Very Important. Were hoping to be in a position of high moral standards. But lets remember. We also have a duty to change things/laws which we feel are unjust. The possibility for change is built into our constitution, and legal system. Heck we were founded in revolution. (Sorry, let me step off my soap box. . . )
ANYWAYS to address the thread again. I think I think I'd say the above, and then admit I might not have the courage to be the first in line to become a martyr, but I can still affect some small change by being honest with others regading my opinions. Personally, I envision prescribing it at the end of my career, when I'm already established. (If indicated and appropriate, etc., ad nauseum) Who knows, maybe I'll find the courage to fight for it. It's not really the highest of my priorities, but yeah, I believe in medical marijuana.

 

[daisygirl]

•••quote:•••Originally posted by none:
•Yeah, the key there is it being legal. It's not, anywhere. Thus the issue should be very easy to respond to.•••••Actually, it is legal to prescribe marijuana in Oregon (I don't know specifics, just know it is true). Just recently in the NY Times, there was an article on a doctor in Oregon who is under investigation for "supposedly" overprescribing marijuana.

 

[med student]

•••quote:••• Med Student: you raise a good point, psychological addiction has real affects; much like placebos in that respect. But it's important to remember a couple things:
1) what population are we talking about? Are we worried about the psychological addiction in patients with serious disorders like cancer? HIV? Are we worried they will sit on the couch all day and not 'be productive'? Is it AS important that they have the willpower to quit? ••••I agree with you completely I was just hate it when people try to say marijuana has no side effects or potential to become addictitive and I was trying to show otherwise. For patients with terminal diseases such as cancer and AIDS I feel they should be given anything to relieve their suffering even if it means grandma is lighting up a crack pipe in her hospital bed. Now I am not advicating crack use I just think that somethimes the medical profession undermedicates terminally ill patients and a big part of it is a fear by doctors that if they prescribe to much pain medication they will get in trouble with the government. I think this is something that needs to change because we are going to have patients who are needlessly suffering because they do not have access to the meds they need.

 

[Scooby Doo]

It's LEGAL IN CALIFORNIA!!!!!

RIGHT?

 

[med student]

•••quote:••• Actually, it is legal to prescribe marijuana in Oregon (I don't know specifics, just know it is true). Just recently in the NY Times, there was an article on a doctor in Oregon who is under investigation for "supposedly" overprescribing marijuana.
••••Actually it is illegal for doctors in any state to prescibe marijuana. States have changed the state law to make it legal but federal law still makes it illegal to prescribe marijuana. I am from CA and we have a similar law to Oregon's but every once in awhile the federal government raids orginizations that provide marijuana to patients with a doctors note and arrests the people in charge. Also when CA's law was first enacted the federal government threatened doctors with the loss of their license if they prescribed marijuana. So basically the laws that the states are enacting are purely symbolic because the federal government can stop the distribution of medical marijuana any time they want. It puts doctors in a tough position because patients think it is legal and they want their doctor to prescribe marijuana for them but the doctors are afraid of getting in trouble.

 

[daisygirl]

•••quote:•••Originally posted by med student:
• •••quote:••• Actually, it is legal to prescribe marijuana in Oregon (I don't know specifics, just know it is true). Just recently in the NY Times, there was an article on a doctor in Oregon who is under investigation for "supposedly" overprescribing marijuana.
••••Actually it is illegal for doctors in any state to prescibe marijuana. States have changed the state law to make it legal but federal law still makes it illegal to prescribe marijuana. I am from CA and we have a similar law to Oregon's but every once in awhile the federal government raids orginizations that provide marijuana to patients with a doctors note and arrests the people in charge. Also when CA's law was first enacted the federal government threatened doctors with the loss of their license if they prescribed marijuana. So basically the laws that the states are enacting are purely symbolic because the federal government can stop the distribution of medical marijuana any time they want. It puts doctors in a tough position because patients think it is legal and they want their doctor to prescribe marijuana for them but the doctors are afraid of getting in trouble.•••••Thanks for the clarification.

 

[oneironaut]

incidentally: chocolate and sex are also psychologically addicting. The concept applies to pretty much anything pleasurable- which is why I don't think its super significant in this type of argument. but anyways. It is something most people don't consider and I was actually glad to see you mention it. 🙂

 

[A. Caveman]

i think my MOM prescribes that stuff. it's given to select anorexics and some cancer patients to stimulate appetite. it does give you the munchies like a mugg. 😀 anyway, it may be "illegal federally" but i don't think it was a big deal from talking to my parents about it. i don't even know if they're aware that it's technically not legal. who gives a crap if it is...doctors (at least here in miami) can and do prescribe it, and it's not a problem. on an earlier thread people were talking about weed and we all found out how uptight many sdners are about mary jane. live a little yall. it's not a big deal to puff the magic dragon every now and again (and again--then give). i'd definitely say that if there were data supporting it's therapeutic value, i would gladly prescribe it..after all one of my goals as a doctor is to ease suffering. whats' the problem with just saying that?? it's as pure an answer as it gets, ain't it?

 

[Doctora Foxy]

•••quote:•••Originally posted by oneironaut:
•incidentally: chocolate and sex are also psychologically addicting. The concept applies to pretty much anything pleasurable- which is why I don't think its super significant in this type of argument. but anyways. It is something most people don't consider and I was actually glad to see you mention it. 🙂 •••••Have you guys ever eaten chocolate during sex while high? It's amazing! <img src="http://www.minorannoyance.net/~spin/Smilies/cwm/cwm/spin2.gif" alt="" /> <img src="http://www.theunholytrinity.org/cracks_smileys/cwm/cwm/rotate.gif" alt="" /> <img src="http://www.theunholytrinity.org/cracks_smileys/contrib/blackeye/stretch.gif" alt="" />

 

[Street Philosopher]

•••quote:•••Originally posted by Scooby Doo:
• •••quote:•••Originally posted by Schoolboy:
•I think it's fairly clear what you should do as a physician. As a physician, not only do you have to follow the ethical guidelines of the profession, but you have to base your decisions on facts and research. Research has repeatedly shown that marijuana has no medical benefits. Furthermore, it is against the law to prescribe marijuana as medicine. It's clear that marijuana should not be prescribed by physicians... at this point in time.•••••Damn dude,
You don't know much about marijuana do you? It has definitely been shown to increase appetite and serve to decrease nasuea. IN ADDITION, you are in Los Ang, CA!!! Last time I looked, Prop 215 (I think it was that one??) passed and marijuana IS LEGAL for CA residents with proper permission.•••••CA is violating federal law, which it has no right in doing.

 

[Street Philosopher]

•••quote:•••Originally posted by oneironaut:
•Okay.. Here's what the AMA says:
Schoolboy: Go do your homework friend.

<a href="http://www.ama-assn.org/ama/pub/article/2036-4971.html" target="_blank">AMA report on Medical Marijuana</a>

Here's another good site , I'm sure many are familiar with PubMed:

<a href="http://www.ncbi.nih.gov/entrez/query.fcgi" target="_blank">PubMed</a>

•••••I am aware of those findings. These "findings" recommend strictly controlled scientific inquiries, implying that there are at this point, none available. Thus there is no PROOF that they work. That is all I was implying. I do realize that there are some INDICATIONS that they might have medicinal effects, which is why I ended my original post as saying "...at this time." I've done my homework, please do not ASSume things about me.

 

[Street Philosopher]

•••quote:•••Originally posted by daisygirl:
• •••quote:•••Originally posted by none:
•Yeah, the key there is it being legal. It's not, anywhere. Thus the issue should be very easy to respond to.•••••Actually, it is legal to prescribe marijuana in Oregon (I don't know specifics, just know it is true). Just recently in the NY Times, there was an article on a doctor in Oregon who is under investigation for "supposedly" overprescribing marijuana.•••••Again, the states have no right in violating federal law.

 

[Street Philosopher]

Please don't accuse people of ignorance. Stick to the issue at hand without saying "You don't know much about X do you?!" or "Do your homework." This doesn't make me feel good and it's not constructive, so cut it out. Thanks.

 

[A. Caveman]

schoolboy, don't you get sick of talking to yourself. how many posts in a row is that now? personally, i think you're being too pretentious. who cares that federal law says one thing and doctors sometiems prescribe it at certain states. why must people step in and say "well...that's wrong." why not just leave it. there's a point to this. if you continue living life with this attitude, you'll come off as pretentious and snotty, and that's not the kind of person anyone wants to be. i've learned that. many times i'm about to comment, and i type it all up..then i just click back on the pre-allopathic link and skip posting it, because it's futile, nobody will change, and making the comment doesn't always help me either. if i'm not saying it to change you, or saying it for myself..why am i saying it? i feel like there's somethign up my butt...very rigid. don't you wanna stop feeling like that? take it or leave it: $0.99

PS. i said this not to change you or whoever reads it, but for myself!

 

[Street Philosopher]

I don't appreciate ad hominem attacks. I don't know about you, but I for one don't have a stick up my ass, nor do I plan on ever having one. Personally, I don't know what your post is supposed to accomplish Caveman. You tell me about typing stuff up and at the last minute thinking better of it, and then you contradict yourself with that post.

Maybe I didn't like the fact that I was regarded as naive and uninformed. Maybe I felt like I needed to respond to those allegations. Maybe it is none of your business whether or not I have a stick up my ass (which I do not), and maybe it is not your place to tell me how to live my life. Maybe.

 

[mongoose]

•••quote:•••Originally posted by Schoolboy:
•
Maybe I didn't like the fact that I was regarded as naive and uninformed. Maybe I felt like I needed to respond to those allegations. Maybe it is none of your business whether or not I have a stick up my ass (which I do not), and maybe it is not your place to tell me how to live my life. Maybe.•••••Maybe you were regarded as naive and uninformed because that is the way your post sounded. In fact, even after all your other posts, that is still what I think. It sounds to me like you are one of those folks who look down their noses at anyone who is not as "moral" as yourself and freely pass judgement on those who you feel are morally inferior to yourself. Maybe this is not how you are. But, maybe this is how you sound. Maybe since more than one person got this impression, you should look at yourself and ask why. Maybe.

 

[PMPMD]

•••quote:•••Originally posted by Doctora Foxy:
•Have you guys ever eaten chocolate during sex while high? It's amazing! •••••That reminds me of the Seinfeld episode where George combines his 3 favorite things: food, TV, and sex.
And no, I haven't had the pleasure of trying that <img border="0" title="" alt="[Frown]" src="frown.gif" />

 

[Street Philosopher]

•••quote:•••Originally posted by mongoose:
• •••quote:•••Originally posted by Schoolboy:
•
Maybe I didn't like the fact that I was regarded as naive and uninformed. Maybe I felt like I needed to respond to those allegations. Maybe it is none of your business whether or not I have a stick up my ass (which I do not), and maybe it is not your place to tell me how to live my life. Maybe.•••••Maybe you were regarded as naive and uninformed because that is the way your post sounded. In fact, even after all your other posts, that is still what I think. It sounds to me like you are one of those folks who look down their noses at anyone who is not as "moral" as yourself and freely pass judgement on those who you feel are morally inferior to yourself. Maybe this is not how you are. But, maybe this is how you sound. Maybe since more than one person got this impression, you should look at yourself and ask why. Maybe.•••••Maybe it is not relevant to you or to me how I sound to you. Maybe it is not your place to give unsolicited advice. Maybe I don't need your paternalistic remarks. MAYBE.

For the record, I do not give unsolicited moral advice to others, nor do I think I am morally superior to others. If you got that impression by reading my posts, then you obviously read too much between the lines. Never did I say prescribing marijuana was wrong, I didn't even say smoking marijuana as a recreational activity is wrong. I simply stated that a physician should conform to the ethical guidelines of his/her profession. If you have trouble with that statement, then feel free to state your views. Nobody told you to tell me how I come across to you.

 

[mongoose]

Schoolboy, I give advice where I feel it is appropriate, not where it is explicitly solicited. If you do not like the advice I give, then disregard it. I just felt like sharing my view of the unfolding situation.

 

[oneironaut]

Whoa, geez. Schoolboy: 'ts cool man.

I don't think that the AMA is saying that their is NO good research on marijuana, theirs actually a lot out there. They're saying more should be done. More research should always be done, and it's the only likely method of fighting an argument that is rooted heavily in 'morality' issues. (In my opinion)

(BTW one good book by the CRC is "Marijuana/Cannabinoids, Neurobiology and Neurophysiology. Edited by Laura Murphy and Andrzej Bartke". It's an article compendium, and sitting here in front of me.)

As for legality:
from the article

(5) The AMA believes that effective patient care requires the free and unfettered exchange of information on treatment alternatives and that discussion of these alternatives between physicians and patients should not subject either party to criminal sanctions.

I translate that to mean, that Ideally, the physician-patient relationship should be sacrosanct.

Maybe it is not relevant to you or to me how I sound to you. Maybe it is not your place to give unsolicited advice. Maybe I don't need your paternalistic remarks. MAYBE.

Personally, I try not to post things if I don't want people to reply to them, you know, discussion board and all.

Schoolboy: Hey man, I think I've stuck to the facts (and not made ad hominem attacks) :wink:
I'd like to know more about your views that it's illegal/unethical (I'm not sure which is more important to you.) Personally I think that what is considered 'ethical' is quite malleable. And if it weren't for dissenters in high places, things would never change. Abortions are/were considered unethical, as birth control too, and numerous other things which are now considered fine, even good by society. Anyways man, really do want your opinion, but yeah, people will give unsolicited remarks on it. But thats cool, it's why we're here [I think]. -Oneiro

 

[Street Philosopher]

oneironaut,

Thanks, no harm no foul.

I don't think medical marijuana use is immoral. If some people think it works for them, that's fine with me. If some doctors think it's okay to prescribe it to patients, I can understand that. Heck, if someone wants to puff the magic dragon occasionally, that's fine with me also. When I say "unethical" I mean to say "not conforming to the ethical guidelines for doctors." In other words, regardless of whether or not it is immoral (I don't think it's immoral), doctors have a responsibility to uphold a code of ethics that they agree to. Part of the code of ethics is to conform to the laws governing acceptable behavior for doctors.

To clarify, I think if we find out that marijuana is helpful to patients, then we should change the law and ethical codes to reflect that. But what I don't think I should do is illegally and unethically break the law. Physicians shouldn't be outlaws, no matter how right they think they are. Physicians are professionals, and should act in a professional manner.

The same view applies to euthanasia. I personally think euthanasia should be legal, and it is the patient's right to decide if euthanasia is right for that individual. However, in most states, passive euthanasia is illegal, and in all states, active euthanasia is illegal. Because of that, if I ever become a physician, I would not perform euthanasia even if I think it is the compassionate and moral thing to do, because I as a professional with a civic responsibility, one who is trusted by society, do not feel it is appropriate for anyone to take the law into one's own hands.

I support changing laws, not breaking them.

I hope that explains my probably oversimplified first response. That's also why I emphasized that current state laws allowing prescription of marijuana for medical purposes is in violation of federal law: to make the point that it is currently unethical to prescribe marijuana for medicinal purposes.